CMS Urges Efforts to Improve Care for Dually Eligible Population
Late last month, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma sent a letter to state Medicaid directors describing ways states can improve care and reduce burdens for individuals who are dually-eligible for both Medicare and Medicaid. This population of individuals tends to have complex medical and behavioral health needs and accounts for a disproportionate share of federal spending for both programs. The letter outlines ten opportunities for states to improve care for the dually-eligible population in 2019.
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CMS Finalizes Changes to Medicare Quality Payment Program
The Centers for Medicare and Medicaid Services (CMS) recently issued final policy changes for Year 3 (2019) of the Quality Payment Program (QPP), as part of the final 2019 Medicare Physician Fee Schedule rule. The final rule updates payment rates and key policies applicable to physicians and other professionals under Medicare. Most notably, the rule expands the types of clinicians (including clinical psychologists) that are eligible to participate in the QPP through the Merit-based Incentive Payment System (MIPS).
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CMS Finalizes Changes to Medicare Physician Payment and Quality Policies
Last week, the Centers for Medicare and Medicaid Services (CMS) released its final rule for the 2019 payment year under Medicare. The rule finalizes policies around reducing provider burden, increasing electronic health record (EHR) interoperability, coverage expansions for telehealth, virtual care, and substance use disorder treatment. Notably, CMS decided to modify its original proposal to significantly change the payment and documentation requirements for traditional outpatient, office-based visits by modifying some elements to address concerns raised by provider groups like the National Council and other stakeholders.
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CMS Proposes Overhaul of Medicare Billing Standards
Last week, the Centers for Medicare and Medicaid Services (CMS) released its proposed rules for the 2019 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP). The proposed rules update payment rates and key policies applicable to physicians and other professionals under Medicare. Among the key changes, the proposed rule would reduce billing documentation requirements, expand telehealth options and potentially create a bundled payment for the care and management of substance use disorders (SUD) in Medicare.
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CMS Updates the Child and Adult Core Health Care Quality Measurement Sets
The Center for Medicaid & CHIP Services (CMCS) recently issued an informational bulletin outlining 2018 updates to the core sets of children’s and adult health care quality measures for beneficiaries in Medicaid and the Children’s Health Insurance Program (CHIP). The core sets are tools states can use, and may voluntarily report on, to monitor and improve the quality of health care provided under their Medicaid and CHIP programs. CMS plans to add new screening measures for mental health and substance use to the Child and Adult Core Sets, while retiring a few behavioral measures found in the Child Core Set.
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Take Action: Submit Your Comments on MACRA Regulations
Thank you to all who provided input on the National Council’s comments on the Medicare Access and CHIP Reauthorization Act (MACRA) Proposed Rule. Considered one of the most significant pieces of Medicare legislation in decades, MACRA eliminates the Sustainable Growth Rate formula, and establishes a new Quality Payment Program that will fundamentally change the way in which Medicare reimburses clinicians. Public comments on the proposed rule are being accepted through Monday June 27, 2016.
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National Council Wins “Transforming Clinical Practices Initiatives” Award
The Department of Health and Human Services (HHS) has awarded $685 million to 39 national and regional collaboratives, including the National Council for Mental Wellbeing, to participate in the Transforming Clinical Practice Initiative. The National Council was awarded a four-year grant to provide technical assistance to clinicians serving individuals with serious mental illnesses in New York.
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CMS Releases Comprehensive Assessment of Quality Measures, Reporting Programs
Yesterday, the Centers for Medicare and Medicaid Services (CMS) released an assessment of quality measures intended to improve the delivery of health care services. The report – completed every three years – examines the effectiveness and impact of each measurement and outlines the performance these measures are having on patients. According to the report, these quality measures are improving care for patients, leading to smarter spending and healthier people.
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HHS Outlines Goals for Tying Medicare and Medicaid Reimbursement to Value-Driven Care
Providers of the future will be paid based on quality and value. That was the message of Department of Health and Human Services (HHS) Secretary Sylvia Burwell this week, as she announced new measurable goals and a timeline intended to move the Medicare program further toward value-driven health care. The Secretary also announced the creation of a Health Care Payment Learning and Action Network, which will involve working with state Medicaid programs, consumers, private payers, employers, providers, and others to expand alternative payment models into their programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models [APMs] and value-based payments.
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CMS Launches Health Care Transformation Initiative
Last week, the Centers for Medicare and Medicaid Services (CMS) announced a new initiative for the development of comprehensive quality improvement strategies to achieve large-scale heath care transformation. The “Transforming Clinical Practice Initiative” is the latest CMS initiative to help clinicians and hospitals move from volume-based to valued-based and patient-centered quality health services. The initiative will provide up to $840 million over the next four years to support 150,000 clinicians in the development of comprehensive quality improvement strategies.
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