Medicare
HHS issues proposed rule to stem Medicare, Medicaid, and CHIP fraud
Posted on September 21, 2010
The Department of Health and Human Services has issued a proposed rule to stem fraud in the Medicare, Medicaid, and Children’s Health Insurance Program under authority created by the health reform law.
According to the agency, the proposed rule will:
- “Establish the requirements for suspending payments to providers and suppliers based on credible allegations of fraud in Medicare and Medicaid;
- “Establish the authority for imposing a temporary moratorium on Medicare, Medicaid, and CHIP enrollment on providers and suppliers when necessary to help prevent or fight fraud, waste, and abuse without impeding beneficiaries’ access to care.
- “Strengthen and build on current provider enrollment and screening procedures to more accurately assure that fraudulent providers are not gaming the system and that only qualified health care providers and suppliers are allowed to enroll in and bill Medicare, Medicaid and CHIP;
- “Outline requirements for states to terminate providers from Medicaid and CHIP when they have been terminated by Medicare or by another state Medicaid program or CHIP;
- “Solicit input on how to best structure and develop provider compliance programs, now required under the Affordable Care Act, that will ensure providers are aware of and comply with CMS program requirements.”
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Kaiser Family Foundation analyzes quality bonuses to Medicare Advantage plans
Posted on September 9, 2010
The Kaiser Family Foundation has issued a new brief examining the implications of the program created by the health reform law to pay bonuses to Medicare Advantage plans with higher quality ratings. It finds that high-quality plans are concentrated in certain states, leaving beneficiaries in other states with little or no access to high-quality plans.
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HHS mails third round of donut hole rebate checks
Posted on August 10, 2010
The Department of Health and Human Services has mailed the third round of one-time $250 rebate checks to more than 750,000 Medicare beneficiaries whose drug costs have placed them in Part D’s “donut hole.”
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CMS explains reform law’s expansion of opportunities for Home and Community Based Services under 1915(i) waiver
Posted on August 10, 2010
In a letter to state Medicaid administrators, the Centers for Medicare and Medicaid Services detailed new opportunities for providing Home and Community Based Services (HCBS) made possible by the health reform law’s modification of 1915(i) waivers. These include allowing states to target certain populations and removing the requirement that patients meet an “institutional level of care” in order to qualify for services.
CMS issues final manufacturers agreement for drug discount program
Posted on August 3, 2010
On Monday CMS issued its ‘doughnut hole’ drug discount agreement for drug makers. According to the agreement, CMS will require drug makers to pay disputed discounts for doughnut hole drugs up front. The agreement extended the time period in which the manufacturers must reimburse quarterly invoices to 38 days, more than double the 15 days originally envisioned by agency officials. CMS also forwarded a memo explaining its provisions.
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CMS reports on savings to Medicare from reform law
Posted on August 2, 2010
In a new report, the Centers for Medicare and Medicaid Services has found that provisions of the health reform law will save the Medicare program almost eight billion dollars by 2012 and more than $575 billion over the next decade. It also projects that the health reform law more than doubles the life of the Medicare Trust Fund.
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CMS proposes payment changes for medicare home health services for 2011
Posted on July 16, 2010
On July 16th CMS accounced a number of payment changes to Medicare home health services, including a 4.75 percent decrease in Medicare payments to home health agencies (HHAs) for calendar year
2011.
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300,000 more Medicare beneficiaries receive donut-hole rebate checks
Posted on July 8, 2010
The Department of Health and Human Services has announced that more than 300,000 additional Medicare beneficiaries whose drug costs have pushed them into the Part D donut hole have been mailed $250 rebate checks funded by the health reform law.
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CMS issues proposed outpatient payment rule reflecting health reform law
Posted on July 6, 2010
The Centers for Medicare and Medicaid Services has issued a proposed rule on payments to hospitals for outpatient and ambulatory surgery centers for 2011.
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Commonwealth issue brief addresses innovative payment approaches
Posted on June 30, 2010
The Center for Medicare and Medicaid Innovation, created by the Affordable Care Act (ACA), has a mandate to develop innovative payment models to improve health care delivery. The aim of this initiative is to achieve higher quality health care delivery and slower cost growth. The Commonwealth Fund Commission on a Higher Performance Health System’s issue brief, “Developing Innovative Payment Approaches: Finding the Path to High Performance,” discusses how the development, implementation, and evaluation of new care payment approaches can be improved, and how those improvements can help achieve the broader goals of health reform. The brief focuses largely on Medicare, but also considers how payment innovation pilots should not be limited to Medicare alone. Instead, payment innovations should also include Medicaid and the Children’s Health Insurance Program (CHIP) to minimize the fragmented nature in which health care is provided.
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