Updates & Analysis

On August 1st, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to update the Medicare hospice payment rate for federal fiscal year (FY) 2019. The rule also finalizes changes to the scope of practice for physician assistants, Hospice Compare website, and Hospice Quality Reporting Program (QRP). Unless otherwise specified, the provisions…

On July 31st, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to update the federal fiscal year (FY) 2019 Medicare payment rates for skilled nursing facilities (SNFs) under the prospective payment system (PPS). The rule also finalizes changes to the case-mix classification system, SNF Quality Reporting Program (QRP), and Value-Based Purchasing…

On July 25th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed Hospital Outpatient Prospective Payment System (OPPS) rule that would update Medicare payment rates for hospital outpatient departments and ambulatory surgery centers (ASCs) for CY 2019. The rule would increase OPPS rates by 1.25%. However, proposed changes to off-campus Provider-Based Department payment…

On July 17th, New York State announced the approval of the annual update to the Value-Based Payment (VBP) Roadmap for Year 3. The Roadmap is part of the Delivery System Reform Incentive Payment (DSRIP) program and outlines the State’s plan to make 80% of Medicaid managed care payments through VBP arrangements by the end of…

As part of the Children’s Medicaid System Transformation, New York State intends to implement six new behavioral health services under the Early and Periodic Screening and Diagnostic Testing benefit in the Medicaid State Plan. These newly established services will offer new community-based supports to Medicaid-enrolled individuals under the age of 21 who meet medical necessity…

On July 19th, the New York State (NYS) Department of Health (DOH) issued a Request for Information (RFI) seeking public input on public need criteria for the licensure of Licensed Home Care Services Agencies (LHCSAs). The NYS Enacted Budget for 2018-19 included a provision to limit the number of LHCSAs by authorizing the Public Health…

On June 28th, the New York City Human Resources Administration’s Department of Social Services released a Request for Proposals (RFP) for the provision of scattered-site supportive housing for young adult families. This housing consists of scattered-site apartments located in multiple buildings integrated into the community, intended to provide residents with affordable, independent housing and access…

On July 12th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update the Physician Fee Schedule and a number of other Medicare payment policies and programs, including updates to the Medicare Shared Savings Program and the Quality Payment Program. Proposed changes impact numerous areas of Medicare reimbursement and reporting,…

Over the past several years, New York State has undertaken a comprehensive Children’s Medicaid and Behavioral Health System Transformation initiative to redesign the health care and social services available to children enrolled in Medicaid. The major objectives of the Transformation include: Implementing Health Home Care Management for children; Creating a new single set of Children and Family Treatment…

On July 2nd, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update Medicare payment rates for home health agencies (HHAs) in CY 2019. Other policy and payment provisions of the rule include: Implementing the Patient-Driven Groupings Model (PDGM), a new case-mix methodology that would change the unit of payment…

On June 25th, the New York State Office of Mental Health (OMH) released a Request for Proposals (RFP) for the operation of a 56-bed scattered-site supportive housing program for adults with serious mental illness (SMI) in Brooklyn. Scattered-site supportive housing consists of studio, one-bedroom, or two-bedroom apartments located in multiple buildings integrated into the community.…

On June 27th, the New York State Department of Health (DOH), released a Request for Applications (RFA) for implementation or expansion of the Project Extension for Community Healthcare Outcomes (ECHO) model in New York State. Awardees will operate a Project ECHO “hub” site at a teaching hospital that will use telecommunications technology to link expert…