Updates & Analysis

The New York City Human Resources Administration (HRA) has released two Requests for Proposals (RFPs) for emergency and transitional housing services for survivors of domestic violence. The RFPs are attached and summarized below. Emergency Shelter and Support Services for Domestic Violence Survivors This RFP offers an anticipated total of $22.8 million over five years for…

On June 17th, CMS released a final rule that will revise the payment methodology for clinical diagnostic laboratory tests (CDLTs) that are paid under the Clinical Laboratory Fee Schedule (CLFS). Under the final rule, applicable labs will be required to report private payer payment rates and volume for CDLTs. CMS will use these private payer…

On June 13th, CMS issued a proposed rule that would update the Conditions of Participation that hospitals and critical access hospitals must meet to be reimbursed by Medicare and Medicaid. Under the proposed rule, all hospitals would be required to implement infection prevention and antibiotic stewardship programs and establish policies that explicitly prohibit discrimination. The…

On June 6th, CMS issued a final rule on the Medicare Shared Savings Program (MSSP). The final rule refines the methodologies used for resetting benchmarks for ACOs that continue to participate in the MSSP after their initial agreement period. The final rule allows ACOs that outperform regional peers to achieve long-term performance-based payments, and further…

New York State has issued an RFP for the development and operation of 1,200 units of Supportive Housing for homeless persons with special needs, available here. Up to $25,000 per unit of services and operations funding will be awarded, for a total of $300 million. This RFP is the first opportunity to receive funding under…

On April 25th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The final rule aligns the rules governing Medicaid managed care with those of other major sources of coverage, including Qualified Health Plans and Medicare Advantage plans. The rule…

On April 27th, the Department of Health and Human Services (HHS) issued a proposed rule to implement provisions of the Medicare Access and CHIP Reauthorization Act (MACRA). Under the proposed rule, the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule would be replaced with the two-tracked Quality Payment Program (QPP).…

On April 21st, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule for FY 2017 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). Attached please find a summary of this rule. CMS will accept comments through June…

On April 21st, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to update the FY 2017 Medicare payment rates under the prospective payment system (PPS) for skilled nursing facilities (SNFs). CMS will accept comments on the proposed rule until June 20th. This document summarizes several major provisions of the proposed rule,…

On April 11th, the Centers for Medicare and Medicaid Services (CMS) announced that the Comprehensive Primary Care Plus (CPC+) model will succeed the existing Comprehensive Primary Care (CPC) initiative, which is due to expire on January 1, 2017. The new advanced primary care medical home model will be tested through the Center for Medicare and…

Late last week, the New York State Legislature passed the 2016-2017 Fiscal Year Budget. Attached please find SPG’s summary of highlighted health care-related provisions from the legislation.

On April 4th, the Centers for Medicare and Medicaid Services (CMS) released the 2017 Rate Announcement and Call Letter, which makes payment and policy updates to Medicare Advantage (MA) and Medicare Part D prescription drug plans. This comes after CMS accepted comments on the Advance Notice and draft Call Letter that was released on February…