Updates & Analysis

On November 2nd, CMS issued a final rule that updates the Physician Fee Schedule (PFS) and other Medicare Part B payment policies for CY 2017. Provisions of the rule include: enrollment and data transparency updates to the Medicare Advantage program, modifications to the Medicare Shared Savings Program, and the expansion of the Diabetes Prevention Program…

On November 1st, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the CY 2017 Hospital OPPS and ASC Payment System. The final rule updates Medicare payment policies and rates for hospital outpatient departments and ambulatory surgery centers. The final rule includes modifications for site-neutral payments, the electronic health record incentive…

On October 31st, the CMS issued a final rule for the CY 2017 Medicare home health prospective payment system (HH PPS). The final rule will update the payment rates for home health agencies (HHAs) in 2017, add new measures to the Home Health Quality Reporting Program, and make changes to the Home Health Value-Based Purchasing…

On October 14th, CMS issued a final rule that will implement provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repeals the Medicare sustainable growth rate (SGR) physician fee schedule methodology and other payment models, and replaces them with a two-tracked Quality Payment Program (QPP). The final rule establishes incentives for…

The New York State Department of Health (DOH), the New York State Office of Mental Health (OMH), and the New York State Office of Alcoholism and Substance Abuse (OASAS) have released guidance for Article 28, Article 31 and Article 32 licensed providers who are interested in co-locating or sharing space either with other licensed providers…

On September 28th, CMS issued a final rule that revises the requirements that long-term care facilities must meet to participate in the Medicare and Medicaid programs. The final rule includes new policies regarding resident rights, facility responsibilities, transitions of care, and comprehensive resident-centered care plans. Unlike the annual provider payment update rules issued by CMS,…

On September 28th, OMH released two RFPs for the operation of up to 88 scattered-site supportive housing units for adults with a serious mental illness (SMI). The RFPs are separated by region and by population. One RFP covers 50 units in New York City for individuals with SMI who were discharged from State Psychiatric Facilities…

On August 29th, CMS issued a proposed rule on benefit and payment parameters for plan years that begin on or after January 1, 2018. The rule proposes standards for issuers and Health Insurance Marketplaces under the Affordable Care Act. Key provisions of the proposed rule include modifications to the risk adjustment program, payment parameters, standardized…

On August 12th, New York State Office of Mental Health (OMH) issued a guidance document regarding the Licensed Behavioral Health Practitioner (LBHP) benefit under the State’s Medicaid 1115 Waiver. The new guidance, effective October 1, 2016, authorizes Medicaid Managed Care Organizations (MMCOs), which include Mainstream Medicaid Managed Care Plans, Health and Recovery Plans, and HIV-Special…

On August 11th, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update the requirements for the PACE program. Under the proposed rule, the PACE program would adopt many of the requirements that currently exist in the Medicare Advantage and Medicare Part D programs for monitoring and compliance. The rule…

On August 5th, the New York City Human Resources Administration (HRA) released an RFP offering $65 million over five years for the development of up to 500 new supportive housing units for homeless persons with a serious mental illness or substance use disorder. The development of these units is part of the City’s plan to…