Center for Medicare and Medicaid Innovation

HHS announces first 26 Health Care Innovation Awards

Posted on May 8, 2012

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the first batch of organizations for Health Care Innovation awards. The awards, a provision under the Affordable Care Act (ACA), will support 26 new innovation projects. The goals of the projects are to lower health care costs, improve quality of care, and enhance the provider workforce. The preliminary awardees announced today expect to reduce health spending by $254 million over the next 3 years.

Projects include…

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments

HHS announces 32 health care organizations to participate in Pioneer ACO Model

Posted on December 19, 2011

Today, the U.S. Department of Health and Human Service (HHS) named 32 health care organizations that will participate in the Pioneer Accountable Care Organization Model. The goal of the new ACO Model is to encourage providers, hospitals, specialists, and caregivers to provide more coordinated care, which could save $1.1 billion over a five year period, HHS projects. The Centers for Medicare & Medicaid Services (CMS) Innovation Center is spearheading this initiative and will reward groups that have formed ACOs based on improvements in health of their Medicare patients and their ability to lower health care costs. Under the Pioneer ACO Model, the 32 selected health care organizations will test the effectiveness of several innovative payment models. The goal of the Pioneer ACO model is to provide better care for beneficiaries, improved coordination with private payers, a reduction Medicare cost growth, and rewards for health care providers that deliver high-quality care. The 32 selected Pioneer ACOs represent urban and rural organizations from various geographic regions of the country, covering 18 states and 860,000 Medicare beneficiaries.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments

HHS issues MLR interim final rule

Posted on December 2, 2011

The U.S. Department of Health and Human Services (HHS) has issued an interim final rule (IFR), with public comment, on the medical loss ratio (MLR) requirement under the Affordable Care Act (ACA). Beginning in 2012, the ACA requires that health insurers spend at least 80% (in some cases 85%) of premiums on health care services, or be required to pay rebates to plan members. HHS issued both the rule itself as well as a separate IFR on the rebate requirements, each allowing for public comment.

For more information on medical loss ratios, click here. An update to the previous brief is pending.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Key Developments, Rulemaking, Rules, and Guidance

CMS announces new deadlines for Advance Payment Model

Posted on November 30, 2011

The Advance Payment Accountable Care Organization (ACO) Model is an initiative developed by the Centers for Medicare and Medicaid (CMS) Innovation Center designed for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). Through the Advance Payment Model, selected participants in the Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn. CMS released a notice today announcing the new application deadline for participation in the Advance Payment Model for certain ACOs. Applications for the performance period beginning on April 1, 2012 will be accepted from January 3, 2012 through February 1, 2012. The period during which applications will be accepted for the performance period beginning on July 1, 2012 will remain identical to the period for the Medicare Shared Savings Program.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments, Medicare

CMS selects 500 FQHCs for Advanced Primary Care Practice demonstration project

Posted on October 24, 2011

The Centers for Medicare and Medicaid Services (CMS) announced today that 500 Federally Qualified Health Centers (FQHCs) have been selected to participate in the Advanced Primary Care Practice demonstration project. These 500 centers will receive $42 million over three years to improve quality and coordination of health care delivery. The project is designed to evaluate the patient-centered medical home model. The goal of the model is to improve patient health and the quality of health care delivery while lowering the cost of of care. HRSA and the Center for Medicare and Medicaid Innovation Center developed the demonstration, which will be conducted from November 1, 2011 through October 31, 2014.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Disparities, Health Care Quality and Delivery System Reform, Health Resources & Services Administration, Key Developments, Medicaid and CHIP, Uncategorized

CMS releases ACO final rule, others agencies weigh-in

Posted on October 20, 2011

The Centers for Medicare and Medicaid Services (CMS) released the much anticipated Accountable Care Organization (ACO) final rule, implementing section 3022 of the Affordable Care Act (ACA), which contains provisions relating to Medicare payments to providers of services and suppliers participating in ACOs under the Medicare Shared Savings Program. The rule on Medicare ACOs relaxes eligibility requirements for doctors and hospitals to participate by halving the number of performance measurements (65 to 33), removing the electronic medical records (EMR) requirement, and eliminating some financial risks. CMS also extended the deadline for ACO applications through 2012. As enticement to rural doctors and physician-owned practices, CMS said it would dedicate $170 million to said providers to start ACOs. Regulators estimate that between 50 and 270 ACOs will be established in the next 3 years, which will affect the care of 4% of Medicare beneficiaries.

Multiple federal agencies also released rules and guidance on fraud & abuse and antitrust issues related to ACOs. The HHS Office of Inspector General (OIG) issued an interim final rule (IFR) on the waiver of certain fraud and abuse provisions and the Department of Justice (DOJ) issued a statement on health care antitrust enforcement policies.

To read more about ACOs, click here.

For the ACO final rule fact sheet, click here.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Department of Justice, Health Care Quality and Delivery System Reform, Health Insurance, Key Developments, Medicare, Office of Inspector General, Rulemaking, Rules, and Guidance

CMS releases details, RFA on bundled payment initiative

Posted on August 24, 2011

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has formerly announced the Bundled Payments for Care Improvement initiative. This initiative, authorized by the Affordable Care Act (ACA), proposes that various provider reimbursements for multiple services a person may receive during the normal course of an illness or injury be bundled together into one payment. The initiative allows broad flexibility for providers to determine which services may be bundled, as well as what share of the single payment may be allocated to each provider. CMS intends for this initiative to improve care coordination and reduce costs in Medicare, and has issued a Request for Applications (RFA) from interested parties on the four (4) different proposed bundling models.

For more information on bundled payments, click here.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Care Quality and Delivery System Reform, Key Developments, Medicare

New Pioneer ACO Model Announced by CMS

Posted on May 20, 2011

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) have announced that the Center for Medicare and Medicaid Innovation (Innovation Center) will support a new type of Accountable Care Organization, called the Pioneer ACO Model. This type of ACO is designed to work in conjunction with both public and private payers and is estimated by the Medicare Chief Actuary to save up to $430 million over 3 years because of better care management and coordination.

“The Pioneer Model is an opportunity for those organizations that have already adopted significant care coordination processes to move further and faster into seamless, coordinated care by utilizing alternative payment mechanisms,” said Richard Gilfillan, M.D., director of the Innovation Center.

CMS will accept applications for Pioneer ACOs through July 18, 2011.

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MedPAC urges tighter performance measures in ACOs

Posted on December 6, 2010

In a letter to CMS Administrator Donald Berwick, the Medicare Patient Advisory Commission urged that the agency establish Accountable Care Organization demonstrations through the Center for Medicare and Medicaid Innovation that not only provide bonuses to providers for improving outcomes at reduced cost, but also penalizes those that fail to do so.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Congressional Documents, Department of Health and Human Services, Key Developments, Medicare

CMS announces launch of Innovation Center

Posted on November 16, 2010

The Centers for Medicare and Medicaid Services has announced the formal launch of the Center for Medicare and Medicaid Innovation, which, the agency explains in its announcement, “will examine new ways of delivering health care and paying health care providers that can save money for Medicare and Medicaid while improving the quality of care.”

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