Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

CMS

CMS to Expand Tailored Benefits for Medicare Advantage Plans

January 31, 2019 - CMS is proposing significant changes to Medicare Advantage geared towards expanding choice and increasing competitiveness in a highly lucrative market. The proposals would increase the number and scope of supplemental benefits available to Medicare Advantage (MA) members and would open up the option of tailoring benefit packages to patients with certain chronic conditions. “CMS...


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Medicare “What’s Covered” App Aims for Price Transparency

by Jessica Kent

CMS has launched a new price transparency app that shows users which medical services and tests are covered under Medicare, the agency announced in a recent blog post.   The free “What’s Covered” app provides users...

CMS Approves Arizona Medicaid Community Engagement Requirement

by Jessica Kent

CMS has approved Arizona’s request to add a community engagement requirement to its section 1115 Medicaid demonstration project, called “Arizona Health Care Cost Containment System” (AHCCCS). After consulting with Native...

CMS Tackles Drug Costs with New Medicare Advantage, Part D Models

by Jessica Kent

CMS’s Center for Medicare and Medicaid Innovation has launched a new payment model and updated an existing model aimed at helping Medicare Part D and Medicare Advantage plans to lower drug prices and better serve...

CMS Mulls End of Auto-Reenrollment, Silver Loading in ACA Market

by Jennifer Bresnick

CMS has issued its proposed Payment Notice for the 2020 plan year, which contains provisions that would significantly alter the operations and structure of the ACA individual marketplace. Continuing a pattern of using CMS regulatory...

Government Shutdown Spares Medicare, Medicaid, But Has Other Impacts

by Jennifer Bresnick

The partial government shutdown will have no impact on Medicare and Medicaid at the federal level, CMS has stressed to industry observers. The nation’s public payers will continue to operate as normal, since funding for CMS is...

Verma: Price Transparency Rule a “First Step” for Consumerism

by Jennifer Bresnick

The hospital price transparency mandate that went into effect on January 1 is still ruffling feathers among healthcare providers, leading CMS Administrator Seema Verma to reiterate the importance of giving consumers access to pricing...

Verma Shares Vision for More State “Flexibility” in Affordable Care Act

by Jessica Kent

CMS has released new policies that purport to help states create “alternatives” to the Affordable Care Act (ACA) and improve health insurance options, according to CMS Administrator Seema Verma. In an address to the States and...

CMS Proposes to Deregulate, Fast Track Medicaid Managed Care Programs

by Thomas Beaton

CMS has proposed a new rule to reduce regulation around Medicaid managed care programs and allow states to contract with private payers to deliver managed care at faster rates. CMS developed the rule in coordination with the National...

CMS to Audit Premium Subsidy Eligibility for Individual Health Plans

by Thomas Beaton

CMS has proposed a new rule that would audit premium subsidy eligibility for individual health plan beneficiaries and monitor premium assistance programs through the federal insurance exchanges. The Patient Protection and Affordable Care...

CMS Redesigns Medicare Home Health Payment with Case Mix Model

by Thomas Beaton

CMS has proposed a new rule that would recalculate Medicare home health payments using a case mix payment model.   In 2020, the agency plans to implement the Patient-Driven Groupings Model (PDGM) to compensate home health agencies...

CMS Extends Medicare Advantage Audit Program in 2019 Rule

by Thomas Beaton

CMS will be continuing its Medicare Advantage audit program, the agency indicated in a proposed 2019 rule, in an effort to ensure program integrity and reduce inappropriate payments to insurers. The changes are part of CMS’s new...

CMS Grants NC 1115 Medicaid Waiver to Implement Managed Care System

by Thomas Beaton

North Carolina has received a 1115 waiver from CMS allowing the state to implement a Medicaid managed care system administered through private payers. The state’s Department of Health and Human Services (DHHS) can now recruit...

New Drug Pricing Model Could Save Medicare Part B $17.2 Billion

by Thomas Beaton

A new drug pricing model with an international component could save Medicare Part B approximately $17.2 billion over five years, CMS says.   The International Pricing Index (IPI) will test if using drug price benchmarks other...

CMS Proposes Drug Price Transparency in Television Ads

by Thomas Beaton

CMS has proposed a new rule that would enhance drug price transparency by requiring drug manufacturers to publish wholesale prices of Medicaid and Medicare prescription drugs during television ads. The proposed rule would require...

Medicare Deductibles, Premiums to Increase Slightly in 2019

by Thomas Beaton

CMS has announced that Medicare Part A and Part B premiums and deductibles are expected to increase slightly for the 2019 plan year. Part B members will see small increases in both their premiums and their deductibles, while Part A...

CMS: ACA Premiums to Decline in 2019 for Silver Plan Consumers

by Thomas Beaton

CMS has announced it expects the average ACA health plan premium to drop by 1.5 percent for healthy consumers that purchase low-cost silver tier plans. The agency stated that it is the first time since 2014 that premiums in any part of...

CMS Releases 2019 Medicare Advantage Health Plan Star Ratings

by Thomas Beaton

CMS has released its 2019 star ratings for Medicare Advantage (MA) health plans, noting that the Medicare Advantage market continues to grow in affordability and access for consumers. CMS estimates that 74 percent of MA beneficiaries will...

OIG Finds Profits to Blame for Denied Medicare Advantage Claims

by Thomas Beaton

Fifty-six percent of Medicare Advantage (MA) payers inappropriately denied claims from beneficiaries and providers to potentially profit from the capitated payment system, according to a report from the Office of Inspector General...

Medicare Advantage Premiums to Decrease by 6% in 2019

by Thomas Beaton

CMS officially announced a six-percent decrease in Medicare Advantage premiums in 2019 as the result of MA enrollment, health plan options, and benefits increase. All signs point to the MA marketplace continuing to be a lucrative...

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