The Centers for Medicare & Medicaid Services (CMS) released Part I of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies (the Advance Notice), which contains key information about proposed updates to the Part C Risk Adjustment Model and the use of encounter data. According to the Press release: The 2019 Advance Notice is being published in two parts this year due to requirements in the 21st Century Cures Act, which mandated … [Read more...] about 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies
CMS Launches Data Submission System for Clinicians in the Quality Payment Program
In a press release, CMS announced that doctors and other eligible clinicians participating in the Quality Payment Program can begin submitting their 2017 performance data using a new system on the Quality Payment Program website (qpp.cms.gov). The Quality Payment Program has two tracks you can choose:Advanced Alternative Payment Models (APMs) orThe Merit-based Incentive Payment System (MIPS)The data submission system is an improvement from the former systems under the CMS legacy programs, which … [Read more...] about CMS Launches Data Submission System for Clinicians in the Quality Payment Program
Texas to receive $25 Billion in Medicaid Funding after Approval of the 1115 Demonstration Waiver
According to The Office of Texas Government news release, the Texas Health and Human Services Commission and the Centers for Medicare and Medicaid Services have reached an agreement to continue a critical part of the state’s Medicaid program over the next five years.The approval of the 1115 Demonstration Waiver will allow the state to continue expanding managed care to Medicaid clients while also preserving supplemental payments to hospitals and other critical Medicaid providers. According to … [Read more...] about Texas to receive $25 Billion in Medicaid Funding after Approval of the 1115 Demonstration Waiver
Enforcement of Obama-era nursing home standards and enforcement remedies halted by CMS
CMS halts enforcement of some standards required by nursing homes that would enhance safety procedures for patients. In this notice: Temporary Enforcement Delays for Certain Phase 2 F-Tags and Changes to Nursing Home Compare posted late last month, the CMS announced an 18-month moratorium on enforcement remedies in some nursing home regulation that was finalized last year.Memorandum Summary from CMS Inlcuded:Temporary moratorium on imposing certain enforcement remedies for specific Phase 2 … [Read more...] about Enforcement of Obama-era nursing home standards and enforcement remedies halted by CMS
Proposed Amendments to streamline ICF/IID & HCS/TxHmL Provider Cost Report Rules
HHSC Report- Effective January 1st 2018, information contained in PPAT on cost report rule changes to be adopted by March 2018, address the implementation of a cost report reform initiative for HCS/TxHmL and ICF/IID providers as required by Texas Health and Human Services Commission (HHSC)On Jan. 1st, HHSC requires only even-year cost reports beginning with the providers’ 2018 fiscal year cost reports for HCS/TxHmL (§355.722(a) and ICF/IID(§355.105(c)(1) )providers. HHSC also proposes … [Read more...] about Proposed Amendments to streamline ICF/IID & HCS/TxHmL Provider Cost Report Rules
CMS Finalizes Policies that Reduce Provider Burden, Lower Prescription Prices
The Centers for Medicare & Medicaid Services (CMS) issued a final rule this month for the 2018 Physician Fee Schedule and final rule with comment period for the Quality Payment Program (QPP). According to a news release by CMS, Seema Verma, Administrator of CMS explained that:“These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and … [Read more...] about CMS Finalizes Policies that Reduce Provider Burden, Lower Prescription Prices
Abuse & poor quality care rate in Texas nursing homes is nearly four times the national average
Many nursing homes have hired Certified Nurse Aides with criminal histories legally. Using data from the federal Centers for Medicare and Medicaid Services, it has been discovered that the patient abuse rate in Texas nursing homes is nearly four times the national average. 25% of the state's 1,200 long-term care centers have been cited for serious standard deficiencies- According to reports by the AARPIn Texas, there are many nurse aides in nursing facilities that have criminal … [Read more...] about Abuse & poor quality care rate in Texas nursing homes is nearly four times the national average
(CMS) requires that Medicare-certified home health agencies (HHAs) meet the Medicare Conditions of Participation (CoPs)
Provider Letter 17-35 DADS released the latest Provider Letter 17-35 – Determination of Separate Entities which replaces PL 01-46 & PL 02-05 for Medicare Certified Home and Community Support Service Agencies. The letter details that the Centers for Medicare and Medicaid Services (CMS) requires that Medicare-certified home health agencies (HHAs) meet the Medicare Conditions of Participation (CoPs) for all clients being served by the agency, regardless of a client’s payment source. The … [Read more...] about (CMS) requires that Medicare-certified home health agencies (HHAs) meet the Medicare Conditions of Participation (CoPs)
Texas lawmakers approve major nursing home quality reforms
According to reports, the 2017 Texas regular legislative session made vast changes affecting older Texans. Lawmakers approved several top priorities for AARP Texas including bills that, among other things, will protect seniors’ financial future, improve access to health care, and help unpaid family caregivers and their families.Also included was major nursing home quality reforms that seek to hold operators of nursing homes and other long-term care facilities more accountable when they have been … [Read more...] about Texas lawmakers approve major nursing home quality reforms
CMS cancels planned Home Health Groupings Payment Model, announces new rule
CMS announced in a rule that it would not move forward with the Home Health Groupings Model. These regulations are effective on January 1, 2018. According to CMS, this final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. The … [Read more...] about CMS cancels planned Home Health Groupings Payment Model, announces new rule